Diabetes and Spinal Cord Injury

People with spinal cord disorders are more prone than most to developing type 2 diabetes. But the condition can be managed and even reversed with diet, exercise and medications.

By Jerome Stenehjem, M.D.

“You are diabetic.” No one wants to hear these words and when they do, they are likely to be in shock or disbelief. “Sure, I’m in a wheelchair, overweight and I don’t get much exercise, but nobody in my family has diabetes,” may be a typical response.

Surprisingly, genetics plays only a limited role in the development of type 2 diabetes, but diabetes now afflicts almost 1 in 10 Americans and a recent study showed that 2 in 10 spinal cord injured veterans are diabetic.

Diabetes mellitus is characterized by elevated blood glucose levels that are due to an inability of the pancreas to produce adequate amounts of insulin. Type 1 or insulin dependent diabetes often occurs in adolescence and results in a complete failure of the pancreas to produce insulin. Type 2 diabetes, formerly called “adult onset diabetes” usually occurs later in life and is characterized by inadequate insulin production that can often be treated with oral medications or lifestyle changes. But oftentimes, type 2 diabetes progresses to the point that insulin injections are required.

At Risk

The risk of developing diabetes is increased if you are sedentary or obese, which are more common among persons with spinal cord injury. Obesity, especially abdominal fat, is closely correlated with type 2 diabetes because fat cells tend to nullify the effects of insulin, resulting in a condition called insulin resistance. With insulin resistance the pancreas works overtime to produce lots of insulin but glucose levels remain high. Eventually the pancreas fails and insulin production falls to extremely low levels. Now the individual may be in a diabetic crisis that can only be treated with insulin injections.